Skip to main content
PMC home page
HHS Author Manuscripts logoLink to HHS Author Manuscripts
. Author manuscript; available in PMC: 2016 Mar 1.
Published in final edited form as: Sleep Med. 2015 Jan 14;16(3):372–378. doi: 10.1016/j.sleep.2014.12.008

Trends in insomnia and excessive daytime sleepiness among US adults from 2002 to 2012

Earl S Ford 1,*, Timothy J Cunningham 1, Wayne H Giles 1, Janet B Croft 1
PMCID: PMC4763609  NIHMSID: NIHMS759511  PMID: 25747141

Abstract

Objective

Insomnia is a prevalent disorder in the United States and elsewhere. It has been associated with a range of somatic and psychiatric conditions, and adversely affects quality of life, productivity at work, and school performance. The objective of this study was to examine the trend in self-reported insomnia and excessive daytime sleepiness among US adults.

Methods

We used data of participants aged ≥18 years from the National Health Interview Survey for the years 2002 (30,970 participants), 2007 (23,344 participants), and 2012 (34,509 participants).

Results

The unadjusted prevalence of insomnia or trouble sleeping increased from 17.5% (representing 37.5 million adults) in 2002 to 19.2% (representing 46.2 million adults) in 2012 (relative increase: +8.0%) (P trend <0.001). The age-adjusted prevalence increased from 17.4% to 18.8%. Significant increases were present among participants aged 18–24, 25–34, 55–64, and 65–74 years, men, women, whites, Hispanics, participants with diabetes, and participants with joint pain. Large relative increases occurred among participants aged 18–24 years (+30.9%) and participants with diabetes (+27.0%). The age-adjusted percentage of participants who reported regularly having excessive daytime sleepiness increased from 9.8% to 12.7% (P trend <0.001). Significant increases were present in most demographic groups. The largest relative increase was among participants aged 25–34 years (+49%). Increases were also found among participants with hypertension, chronic obstructive pulmonary disease, asthma, and joint pain.

Conclusions

Given the deleterious effects of insomnia on health and performance, the increasing prevalence of insomnia and excessive daytime sleepiness among US adults is a potentially troubling development.

Keywords: Arthralgia, Diabetes, Health surveys, Insomnia, Population surveillance, Trends

1. Introduction

Inadequate sleep as a public health concern has awakened from a deep slumber in recent decades [1]. Sleep health is a multidimensional field of study, and insomnia constitutes a key component of sleep health. The 2006 Institute of Medicine (IOM) report defined insomnia as “having difficulty falling asleep, maintaining sleep, or by short sleep duration, despite adequate opportunity for a full night’s sleep” [1]. Although several approaches to the nosology of insomnia exist (International Classification of Diseases-10, Diagnostic and Statistical Manual for Mental Disorders and the International Classification of Sleep Disorders) [2–4], national estimates of the prevalence of insomnia emanate from surveys that employ simple questions. Insomnia in the United States is common with reported population-based estimates ranging from about 15% to 24% [5,6].

Insomnia affects cognitive functioning [7], leads to depression [8], and may be comorbid with several psychiatric and medical conditions [9]. Furthermore, insomnia has been associated with heart disease in prospective and retrospective epidemiologic studies [10–13], and insomnia or symptoms thereof have been associated with increased mortality in some prospective studies [13–15] but not in others [16–18]. Among those who report to be suffering from insomnia, those who sleep fewer than six hours have been reported to be at increased risk for adverse health events [14]. Furthermore, insomnia increases the risk for automobile accidents and results in worse quality of life, increased disability, increased work absenteeism [19], and increased use of the health care system. The economic costs of insomnia are poorly understood but are nevertheless thought to be substantial: the direct economic costs attributed to insomnia were estimated to have been $13.9 billion in 1995 [20], and estimates of total costs have ranged from $30 billion to $107.5 billion [20,21].

Given the range of adverse impacts and the economic costs associated with this disorder, having current information about trends in the prevalence of insomnia is vital to describing the scope of the problem in part to provide guidance about allocation of resources for preventing and treating insomnia. Because little information about recent trends in insomnia is available, our objective was to examine the trend on self-reported insomnia and excessive daytime sleepiness among adults in the United States.

2. Methods

We used cross-sectional data about insomnia from the National Health Interview Survey, which was available for the years 2002, 2007, and 2012 [22]. Since 1957, the National Health Interview Survey, conducted by the National Center for Health Statistics, has selected a representative sample of the civilian noninstitutionalized population using a multistage area probability design. During the first stage, a sample was drawn from a universe of primary sampling units (single counties or groups of adjacent counties or equivalent jurisdictions and/or metropolitan areas) that were divided into self-representing and non-self-representing primary sampling units. During the second stage, substrata were created from Census blocks or combined blocks, and clusters of dwelling units were created within the substrata and were subsequently systematically sampled. From selected dwelling units, one adult was randomly sampled for the Sample Adult component. Interviewers employed by the U.S. Census Bureau received annual training in the procedures of the surveys and conducted the interviews using computer assisted personal interviewing with selected participants in their homes. Black and Hispanic persons were oversampled in all three surveys and Asians were oversampled in 2007 and 2012. A revised survey sampling design was introduced in 2006. The overall household response rates for the three years were 89.6%, 87.1%, and 77.6%, respectively. Household response rates were calculated as: interviewed households /(interviewed households + Type A non-response households). Reasons for being classified as a Type A non-response households include language problems, no one was at home after repeated contact attempts, family temporarily absent, refusal, household records rejected for insufficient data, household records rejected for other CAPI related problems, or other reasons for no interview. The final response rates for the Sample Adult component (final family response rate * [interviewed sample adults / eligible sample adults from Interviewed families]) were 74.3%, 67.8%, and 61.2%, respectively. Sampling weights were constructed based on probabilities of selection with adjustments for nonresponse and post-stratification. Because this study used publically available data, it was exempt from human subjects review.

Participants who responded affirmatively to the question “During the past 12 months, have you regularly had insomnia or trouble sleeping?” were defined as having insomnia. Participants who responded affirmatively to the question “During the past 12 months, have you regularly had excessive sleepiness during the day?” were deemed to have experienced excessive daytime sleepiness. Covariates included age, gender, and race or ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other).

We also examined the trends in several factors that may be related to insomnia including heavy drinking, binge drinking, smoking status, obesity, and employment status. Heavy drinking was defined as men who had on average more than two alcoholic beverages per day and women who had on average more than one alcoholic beverage per day. Binge drinking was defined as adults who on at least one day during the past year had five or more drinks (In the past year, on how many days did you have five or more drinks of any alcoholic beverage?). Current smoking was defined as having smoked at least 100 cigarettes during one’s life and still smoking at the time of the interview. Obesity was defined as a body mass index ≥30 kg/m2 calculated from self-reported weight and height. Participants who were seeking work were identified from the question “Which of the following was person doing last week?”

We limited analyses to adults aged ≥18 years. Age-adjusted estimates were calculated using the direct method with the year 2000 projected US population as the standard. Analyses using sampling weights were performed in SAS and SUDAAN to account for the complex sampling design.

3. Results

The number of participants aged ≥18 years were 31,044 in 2002, 23,393 in 2007, and 34,525 in 2012. After excluding participants with missing values for the questions about insomnia and excessive daytime sleepiness, the sample sizes for this study were reduced to 30,970 (99.8%), 23,344 (99.8%), 34,509 (99.9%), respectively. Mean age increased significantly from 45.2 years in 2002 to 46.6 years in 2012 (P trend <0.001). The percentage of men remained stable (P trend = 0.799), and the percentage of white participants decreased significantly from 73.1% in 2002 to 67.2% in 2012 (P < 0.001).

The unadjusted prevalence of insomnia increased from 17.5% (an estimated 37.5 million adults) in 2002 to 19.2% (an estimated 46.2 million adults) in 2012. The age-adjusted prevalence of insomnia or trouble sleeping increased from 17.4% to 18.8% (relative increase: +8.0%, P trend <0.001). Significant increases were observed among participants aged 18–24 years, 25–34 years, 55–64 years, and 65–74 years, men, women, whites and Hispanics (Table 1). Among the demographic groups, the largest relative increase occurred among participants aged 18–24 years (+30.9%). The prevalence of insomnia tended to increase with age although the prevalence peaked among participants aged 55–64 years in 2002 and 2012. In all three years, the prevalence was higher in women than men and was highest among whites.

Table 1.

Age-adjusted prevalence (standard error) of insomnia among participants aged ≥18 years, National Health Interview Survey 2002–2012.

2002
 2007
 2012
 P trend
N % (SE) N % (SE) N % (SE)
Total-crude 30970 17.5 (0.3) 23344 18.1 (0.3) 34509 19.2 (0.3) <0.001
Total-age-adjusted 30970 17.4 (0.3) 23344 18.0 (0.3) 34509 18.8 (0.3) <0.001
Age (years)
  18–24 3358 11.4 (0.7) 2493 11.8 (0.8) 3416 14.9 (0.8) 0.001
  25–34 5865 12.9 (0.5) 4189 14.1 (0.7) 6111 15.6 (0.6) 0.001
  35–44 6480 17.6 (0.5) 4334 16.6 (0.7) 5759 16.6 (0.6) 0.210
  45–54 5470 21.1 (0.7) 4364 20.5 (0.7) 5952 22.0 (0.7) 0.358
  55–64 3962 22.1 (0.8) 3397 22.1 (0.8) 5893 24.2 (0.7) 0.043
  65–74 2955 18.6 (0.8) 2408 21.6 (1.0) 3975 21.3 (0.9) 0.022
  75 + 2880 20.5 (0.9) 2159 24.6 (1.1) 3403 20.7 (0.9) 0.871
Sex
  Men 13474 14.2 (0.4) 10343 15.2 (0.4) 15267 15.6 (0.4) 0.008
  Women 17496 20.3 (0.4) 13001 20.5 (0.4) 19242 21.8 (0.4) 0.009
Race or ethnicity
  White 20382 18.2 (0.3) 14019 19.0 (0.4) 20831 19.8 (0.4) 0.001
  African American 4178 15.8 (0.7) 3696 16.8 (0.8) 5279 16.5 (0.6) 0.442
  Hispanic 5267 16.6 (0.7) 4192 16.9 (0.8) 5858 19.3 (0.7) 0.005
  Others 1143 11.5 (1.1) 1437 13.1 (1.2) 2541 13.3 (0.9) 0.209
Hypertension
  Yes 6366 29.4 (1.2) 5447 27.5 (1.1) 8320 31.0 (1.2) 0.343
  No 24492 15.3 (0.3) 17838 15.4 (0.3) 24566 16.6 (0.3) 0.004
Any coronary heart disease
  Yes 2010 37.8 (3.3) 1553 40.8 (4.2) 2520 38.3 (3.2) 0.917
  No 28893 16.4 (0.3) 21752 17.1 (0.3) 31943 18.1 (0.3) <0.001
Stroke
  Yes 787 37.3 (4.4) 646 37.1 (4.0) 1113 39.8 (4.1) 0.675
  No 30147 17.1 (0.3) 22680 17.6 (0.3) 33377 18.4 (0.3) 0.001
Cancer
  Yes 2258 32.0 (2.1) 1780 31.6 (2.2) 3115 31.1 (2.1) 0.761
  No 28684 16.7 (0.3) 21549 17.2 (0.3) 31380 18.2 (0.3) <0.001
Diabetes
  Yes 2179 25.3 (1.7) 2028 31.6 (3.3) 3526 32.1 (2.0) 0.009
  No 28476 16.6 (0.3) 21089 17.2 (0.3) 30473 17.9 (0.3) 0.001
Chronic obstructive pulmonary disease
  Yes 1791 39.9 (1.5) 1090 44.3 (2.1) 1773 43.9 (1.9) 0.098
  No 29168 16.2 (0.3) 22247 16.8 (0.3) 32731 17.7 (0.3) <0.001
Asthma
  Yes 2159 35.7 (1.1) 1746 32.4 (1.4) 2865 33.4 (1.1) 0.142
  No 28729 16.1 (0.3) 21558 16.8 (0.3) 31591 17.5 (0.3) <0.001
Joint pain
  Yes 9305 32.0 (0.7) 6554 34.4 (0.9) 10974 35.0 (0.7) 0.002
  No 21624 11.7 (0.3) 16773 12.2 (0.3) 23522 12.5 (0.3) 0.025
Current smoking
  Yes 6913 21.9 (0.6) 4365 24.7 (0.9) 6435 25.6 (0.8) <0.001
  No 23733 15.9 (0.3) 18588 16.0 (0.3) 27808 17.0 (0.3) 0.005
Heavy drinking
  Yes 1534 21.3 (1.1) 1106 22.7 (1.5) 1759 26.1 (1.4) 0.008
  No 28451 17.4 (0.3) 21342 17.9 (0.3) 32021 18.5 (0.3) 0.005
Binge drinking
  Yes 5732 17.3 (0.8) 4262 19.7 (1.0) 7227 20.0 (0.7) 0.009
  No 24189 17.1 (0.3) 18035 17.5 (0.4) 26395 18.1 (0.3) 0.029
Looking for work
  Yes 1103 23.0 (1.8) 647 22.5 (1.8) 2077 26.8 (2.8) 0.247
  No 29804 17.2 (0.3) 22664 17.8 (0.3) 32408 18.3 (0.3) 0.005
Body mass index ≥30 kg/m2
  Yes 8663 21.0 (0.5) 7116 21.6 (0.6) 10918 22.4 (0.5) 0.053
  No 22307 16.0 (0.3) 16228 16.3 (0.3) 23591 17.2 (0.3) 0.010
Open in a new tab

Among participants with a comorbid condition, the prevalence of insomnia increased only among participants with diabetes and among participants with joint pain (Table 1). The relative increase in the prevalence of insomnia was particularly large among participants with diabetes (+27.0%). In each year, people with a chronic condition had a significantly higher prevalence of insomnia than those without the condition.

The prevalence of insomnia increased significantly among adults who were current smokers and those who were not, among those who were heavy drinkers and those who were not, among those who reported binge drinking and those who did not, and among those with a body mass index <30 kg/m2(Table 1). Furthermore, participants who were smokers, heavy drinkers, binge drinkers (2012 only), and obese had a significantly higher prevalence of insomnia than their counterparts in each of the survey years.

We also examined trends in adults reporting excessive daytime sleepiness (Table 2). The age-adjusted percentage of participants who reported regularly having excessive daytime sleepiness increased from 9.8% in 2002 (21.0 million adults) to 12.7% (30.5 million adults) in 2012 (P trend <0.001). Significant increases were present in all demographic groups except among participants of described as being of another race or ethnicity not white, black, or Hispanic. The largest relative increase was among participants aged 25–34 years (+49%). Furthermore, significant increases were also found among participants with hypertension, chronic obstructive pulmonary disease, asthma, and joint pain. In each year, adults with a chronic condition had a significantly higher prevalence of excessive daytime sleepiness than those without a chronic condition.

Table 2.

Age-adjusted prevalence (standard error) of excessive daytime sleepiness among participants aged ≥18 years, National Health Interview Survey 2002–2012.

2002
 2007
 2012
 P trend
N % (SE) N % (SE) N % (SE)
Total-crude 30970 9.8 (0.2) 23344 10.2 (0.2) 34509 12.7 (0.3) <0.001
Total-age-adjusted 30970 9.8 (0.2) 23344 10.2 (0.2) 34509 12.7 (0.3) <0.001
Age (years)
  18–24 3358 10.7 (0.7) 2493 9.6 (0.8) 3416 14.5 (0.8) <0.001
  25–34 5865 8.8 (0.5) 4189 9.7 (0.5) 6111 13.1 (0.5) <0.001
  35–44 6480 9.4 (0.4) 4334 9.2 (0.5) 5759 11.3 (0.5) 0.006
  45–54 5470 10.1 (0.5) 4364 9.9 (0.6) 5952 12.5 (0.6) 0.002
  55–64 3962 9.4 (0.5) 3397 10.5 (0.6) 5893 12.1 (0.5) <0.001
  65–74 2955 8.8 (0.6) 2408 10.8 (0.8) 3975 11.5 (0.6) 0.003
  75 + 2880 12.5 (0.7) 2159 14.5 (0.9) 3403 15.1 (0.9) 0.019
Sex
  Men 13474 8.6 (0.3) 10343 8.9 (0.3) 15267 10.8 (0.3) <0.001
  Women 17496 11.0 (0.3) 13001 11.5 (0.3) 19242 14.5 (0.3) <0.001
Race or ethnicity
  White 20382 10.2 (0.3) 14019 10.9 (0.3) 20831 13.7 (0.4) <0.001
  African American 4178 9.4 (0.5) 3696 9.5 (0.6) 5279 12.0 (0.5) 0.001
  Hispanic 5267 8.8 (0.5) 4192 9.2 (0.6) 5858 10.9 (0.5) 0.005
  Others 1143 8.1 (1.0) 1437 8.5 (0.9) 2541 10.0 (1.0) 0.155
Hypertension
  Yes 6366 17.5 (1.0) 5447 17.3 (1.0) 8320 22.8 (1.3) 0.001
  No 24492 8.4 (0.2) 17838 8.6 (0.2) 24566 10.8 (0.3) <0.001
Any coronary heart disease
  Yes 2010 25.6 (3.2) 1553 17.9 (1.7) 2520 32.7 (2.9) 0.102
  No 28893 9.1 (0.2) 21752 9.7 (0.2) 31943 11.9 (0.2) <0.001
Stroke
  Yes 787 32.9 (4.8) 646 21.1 (2.9) 1113 35.0 (4.2) 0.739
  No 30147 9.4 (0.2) 22680 9.8 (0.2) 33377 12.2 (0.3) <0.001
Cancer
  Yes 2258 20.4 (1.7) 1780 21.9 (2.4) 3115 24.2 (2.2) 0.171
  No 28684 9.3 (0.2) 21549 9.9 (0.2) 31380 12.1 (0.2) <0.001
Diabetes
  Yes 2179 21.9 (1.8) 2028 20.3 (2.0) 3526 24.5 (2.2) 0.362
  No 28476 9.0 (0.2) 21089 9.3 (0.2) 30473 11.6 (0.2) <0.001
Chronic obstructive pulmonary disease
  Yes 1791 28.0 (1.5) 1090 30.7 (2.1) 1773 35.3 (2.0) 0.003
  No 29168 8.8 (0.2) 22247 9.3 (0.2) 32731 11.6 (0.2) <0.001
Asthma
  Yes 2159 20.6 (1.1) 1746 19.8 (1.1) 2865 24.9 (1.1) 0.005
  No 28729 9.0 (0.2) 21558 9.4 (0.2) 31591 11.6 (0.3) <0.001
Joint pain
  Yes 9305 19.3 (0.6) 6554 20.9 (0.8) 10974 24.7 (0.7) <0.001
  No 21624 6.3 (0.2) 16773 6.6 (0.2) 23522 8.1 (0.2) <0.001
Current smoking
  Yes 6913 13.6 (0.5) 4365 13.7 (0.7) 6435 17.8 (0.7) <0.001
  No 23733 8.6 (0.2) 18588 9.1 (0.3) 27808 11.4 (0.3) <0.001
Heavy drinking
  Yes 1534 9.5 (0.9) 1106 10.3 (1.1) 1759 14.0 (1.1) 0.001
  No 28451 9.9 (0.2) 21342 10.3 (0.3) 32021 12.5 (0.3) <0.001
Binge drinking
  Yes 5732 10.3 (0.6) 4262 10.4 (0.7) 7227 12.2 (0.6) 0.021
  No 24189 9.6 (0.3) 18035 10.1 (0.3) 26395 12.4 (0.3) <0.001
Looking for work
  Yes 1103 11.8 (1.4) 647 11.3 (1.4) 2077 14.1 (0.9) 0.180
  No 29804 9.7 (0.2) 22664 10.1 (0.2) 32408 12.4 (0.3) <0.001
Body mass index ≥30 kg/m2
  Yes 8663 13.4 (0.4) 7116 14.0 (0.5) 10918 16.8 (0.5) <0.001
  No 22307 8.4 (0.2) 16228 8.5 (0.3) 23591 10.7 (0.3) <0.001
Open in a new tab

Among persons reporting insomnia only about a third also reported excessive daytime sleepiness during each survey. Trends in combinations of insomnia and excessive daytime sleepiness are shown in Table 3.

Table 3.

Age-adjusted prevalence (standard error) of insomnia and excessive daytime sleepiness among adults aged ≥18 years, National Health Interview Survey 2002–2012.

Insomnia +, excessive daytime sleepiness +
 Insomnia +, excessive daytime sleepiness −
2002 2007 2012 P trend 2002 2007 2012 P trend
Total-crude 6.2 (0.2) 6.2 (0.2) 7.0 (0.2) 0.002 11.2 (0.2) 11.9 (0.3) 12.2 (0.2) 0.003
Total-age-adjusted 6.2 (0.2) 6.1 (0.2) 7.0 (0.2) 0.002 11.2 (0.2) 11.8 (0.2) 11.8 (0.2) 0.060
Age (years)
  18–24 6.3 (0.5) 5.2 (0.6) 7.1 (0.6) 0.341 5.1 (0.5) 6.6 (0.6) 7.8 (0.6) <0.001
  25–34 5.6 (0.3) 5.2 (0.4) 6.7 (0.4) 0.031 7.4 (0.4) 9.0 (0.6) 8.9 (0.5) 0.015
  35–44 6.6 (0.3) 5.6 (0.4) 6.8 (0.4) 0.732 11.0 (0.4) 11.0 (0.6) 9.8 (0.5) 0.067
  45–54 7.3 (0.4) 6.8 (0.4) 7.6 (0.5) 0.531 13.8 (0.5) 13.7 (0.6) 14.3 (0.6) 0.523
  55–64 6.2 (0.4) 7.4 (0.6) 7.8 (0.4) 0.007 15.9 (0.7) 14.7 (0.7) 16.4 (0.6) 0.617
  65–74 4.7 (0.4) 6.5 (0.6) 6.0 (0.5) 0.055 13.9 (0.7) 15.1 (0.8) 15.3 (0.7) 0.155
  75 + 5.7 (0.5) 7.8 (0.7) 6.6 (0.5) 0.236 14.8 (0.8) 16.7 (0.9) 14.1 (0.8) 0.564
  Sex
  Men 5.3 (0.2) 5.1 (0.3) 5.8 (0.3) 0.093 9.0 (0.3) 10.1 (0.4) 9.8 (0.3) 0.057
  Women 7.1 (0.2) 7.1 (0.3) 8.1 (0.3) 0.006 13.2 (0.3) 13.4 (0.3) 13.7 (0.3) 0.286
Race or ethnicity
  White 6.5 (0.2) 6.6 (0.3) 7.6 (0.3) 0.002 11.7 (0.3) 12.4 (0.3) 12.3 (0.3) 0.146
  African American 5.9 (0.5) 5.3 (0.4) 6.5 (0.4) 0.291 10.0 (0.5) 11.5 (0.7) 10.0 (0.5) 0.945
  Hispanic 5.9 (0.5) 5.8 (0.5) 6.1 (0.3) 0.795 10.6 (0.6) 11.1 (0.6) 13.2 (0.7) 0.003
  Others 4.1 (0.6) 4.7 (0.8) 5.0 (0.6) 0.277 7.5 (0.9) 8.4 (0.8) 8.3 (0.7) 0.477
Insomnia −, excessive daytime sleepiness +
 Insomnia −, excessive daytime sleepiness −
2002 2007 2012 P trend 2002 2007 2012 P trend
Total-crude 3.6 (0.1) 4.0 (0.2) 5.7 (0.2) <0.001 79.0 (0.3) 77.8 (0.3) 75.1 (0.3) <0.001
Total-age-adjusted 17.4 (0.3) 18.0 (0.3) 18.8 (0.3) <0.001 79.0 (0.3) 78.0 (0.3) 75.5 (0.3) <0.001
Age (years)
  18–24 4.4 (0.4) 4.4 (0.5) 7.4 (0.6) <0.001 84.2 (0.8) 83.8 (0.9) 77.7 (0.9) <0.001
  25–34 3.3 (0.3) 4.6 (0.4) 6.4 (0.4) <0.001 83.8 (0.6) 81.3 (0.8) 78.0 (0.7) <0.001
  35–44 2.8 (0.2) 3.7 (0.3) 4.5 (0.4) <0.001 79.6 (0.5) 79.7 (0.8) 78.9 (0.7) 0.451
  45–54 2.9 (0.3) 3.1 (0.4) 4.8 (0.4) <0.001 76.1 (0.7) 76.4 (0.8) 73.2 (0.8) 0.007
  55–64 3.2 (0.3) 3.2 (0.3) 4.3 (0.3) 0.015 74.7 (0.8) 74.8 (0.8) 71.5 (0.7) 0.003
  65–74 4.0 (0.4) 4.4 (0.5) 5.4 (0.5) 0.024 77.3 (0.9) 74.0 (1.1) 73.2 (0.9) 0.001
  75 + 6.8 (0.6) 6.7 (0.6) 8.5 (0.7) 0.044 72.7 (1.0) 68.7 (1.1) 70.7 (1.1) 0.169
Sex
  Men 3.3 (0.2) 3.8 (0.2) 5.0 (0.2) <0.001 82.4 (0.4) 81.0 (0.5) 79.4 (0.4) <0.001
  Women 3.9 (0.2) 4.4 (0.2) 6.4 (0.2) <0.001 75.8 (0.4) 75.1 (0.5) 71.9 (0.4) <0.001
Race or ethnicity
  White 3.7 (0.2) 4.2 (0.2) 6.1 (0.2) <0.001 78.1 (0.4) 76.8 (0.4) 74.0 (0.4) <0.001
  African American 3.6 (0.3) 4.2 (0.4) 5.5 (0.4) <0.001 80.6 (0.7) 79.0 (0.9) 78.0 (0.7) 0.012
  Hispanic 2.9 (0.3) 3.5 (0.4) 4.9 (0.4) <0.001 80.6 (0.7) 79.6 (0.8) 75.9 (0.8) <0.001
  Others 4.0 (0.8) 3.8 (0.7) 5.0 (0.7) 0.336 84.5 (1.4) 83.1 (1.3) 81.6 (1.1) 0.108
Open in a new tab

Figure 1 shows the age-adjusted estimates for several lifestyle factors that could have influenced the trend in insomnia. Significant trends were noted for binge drinking, smoking status, obesity, and employment status (all P trend <0.001) but not heavy drinking (P trend = 0.747).

Fig. 1.

Fig. 1

Open in a new tab

Age-adjusted percentages (95% confidence interval) of selected factors among US adults aged ≥18 years, National Health Interview Survey. Sample sizes ranged from 29,971 to 31,044 in 2002, 22,331 to 23,393 in 2007, and 33,635 to 34,525 in 2012.

4. Discussion

As the importance of adequate sleep has become increasingly appreciated, surveillance of sleep health is vital in describing the magnitude of a public health problem. Insomnia represents an important aspect of sleep health. Our analyses of national samples of US adults show that the percentages of adults who report regularly having insomnia or trouble sleeping and/or daytime sleepiness increased from 2002 to 2012. Our unadjusted estimates of insomnia increased from 17.5% to 19.2%, of excessive daytime sleepiness from 9.8% to 12.7%, and the combination of insomnia and excessive daytime sleepiness from 6.2% to 7.0%. Because of the adverse health consequences that have been attributed to insomnia, the increasing trend is an unwelcome development.

A prevalence of insomnia of about 10% among US adults is a commonly cited figure, but some estimates are much higher [1,23]. In an analysis of data from the 1979 National Survey of Psychotherapeutic Drug Use, the prevalence of insomnia among noninstitutionalized US adults aged 18–79 years was 35% [24]. Different approaches to defining insomnia are quite likely to produce varying prevalence estimates.

Previously, little was known about trends in the prevalence of insomnia in the United States, and, therefore, the information contained in this report helps to fill a gap in the knowledge base concerning sleep health. The increasing trend in the prevalence of insomnia and excessive daytime sleepiness in US adults that we demonstrated appears to parallel trends in several countries. In Finland, the prevalence of occasional insomnia in working age adults increased from the 1970s to the early 2000s [25]. In England, insomnia symptoms, insomnia of at least moderate severity, insomnia and fatigue, and insomnia diagnosis among survey participants aged 16– 64 years increased by 6%, 5%, 4%, and 3%, respectively, from 1993 to 2007 [26]. In Taiwan, the prevalence of insomnia defined on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification codes among National Health Insurance enrollees increased significantly from 2.5% in 2002 to 4.2% during 2009 [27]. In Norway, the prevalence of insomnia increased significantly from 13.1% during 1999–2000 to 15.2% during 2009–2010 [28].

The reasons why people experience insomnia are numerous and include behavioral, health-related, psychological, and societal reasons [9]. Thus, population-level changes in any of these domains may have influenced the numbers of adults who experienced insomnia. The following explanations for increases in the prevalence of insomnia in other countries have been postulated: increases in health problems, increases in body mass index, changes in occupational factors such as stress and shiftwork, sleep habits, and the increasingly ubiquitous availability of electronic devices [25,28]. The jump in the prevalence of diabetes in the United States in recent decades is one example of how health problems have increased. Interestingly, the increase in reported insomnia by participants with diabetes was especially noteworthy. We noted significantly increasing trends in the prevalence of consumption of ≥5 drinks in a single day at least once during the past year and in obesity. Furthermore, the percentage of adults seeking work was substantially higher in 2012 than earlier years. The trends of these factors could possibly have influenced the trend in the prevalence of insomnia [29–31]. However, the declining prevalence of smoking could have counterbalanced some of these other influences [32]. An alternative explanation for the findings is that the trends possibly reflect a type of awareness bias.

Young adulthood is a critical period during the life course when behaviors may start to settle in, and the foundations for chronic conditions that emerge later in life take hold. Thus, the large relative increase in the prevalence of insomnia that occurred among participants aged 18–24 years is a cause for concern. This may reflect lifestyles including access to technologies and beverage choices that inhibit sleep. A personal history of insomnia has been shown to be a risk factor for subsequent insomnia [33], and consequently the onset of insomnia during early adulthood may portend a steeper burden of lifetime insomnia. Furthermore, insomnia has been linked to conditions such as obesity, diabetes, and cardiovascular disease, and if insomnia indeed plays a role in the etiology of these conditions, an early manifestation of insomnia could speed the onset of these conditions. Insomnia has also been linked to depression in prospective studies in young adults [34]. Unfortunately, information was not obtained about depression from respondents. Nevertheless, our findings should stimulate investigations into the reasons underlying the trend in young adulthood and of the potential ramifications thereof. From 1978 to 1988, the percentage of college students who reported being dissatisfied with their sleep increased from 24.4% to 53.4% [35].

Several limitations bear mention. First, the validity and reliability of the NHIS questions used to define insomnia and excessive daytime sleepiness are unproven. No uniformly accepted approach to defining insomnia in epidemiological studies and national surveillance systems currently exists although a number of insomnia questionnaires have been developed. Epidemiological definitions of insomnia differ from clinical definitions of insomnia that employ more stringent criteria [6,36]. Hence, we cannot say unambiguously that the trends we described for our epidemiological definition of insomnia might have been mimicked by a clinical definition of insomnia. The consistent wording of the questions across time increases confidence in the trends that we reported. Second, we were unable to distinguish primary from secondary insomnia. Third, all data of the NHIS were self-reported and subject to a variety of biases.

In conclusion, the prevalence of insomnia as reported by US adults rose steadily from 2002 to 2012. If our results are confirmed by other data sources, more research on the reasons underlying any increase is warranted to develop evidence-based approaches in alleviating an apparently growing public health problem.

Acknowledgments

Funding source

None

Footnotes

Conflict of interest

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2014.12.008.

References

  • 1.Institute of Medicine, Committee on Sleep Medicine and Research, Board on Health Sciences Policy. Sleep disorders and sleep deprivation: an unmet public health problem. Washington, DC: National Academy of Sciences; 2006. [Google Scholar]
  • 2.World Health Organization. International classification of diseases (ICD-10) Geneva, Switzerland: World Health Organization; 1991. [Google Scholar]
  • 3.American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV-TR) 4th. Washington, DC: American Psychiatric Association; 2000. Text Revision. [Google Scholar]
  • 4.American Academy of Sleep Medicine. International classification of sleep disorders: diagnostic and coding manual (ICSD-2) 2nd. Rochester (MN): Sleep Disorders Association; 2005. [Google Scholar]
  • 5.Pearson NJ, Johnson LL, Nahin RL. Insomnia, trouble sleeping, and complementary and alternative medicine: Analysis of the 2002 national health interview survey data. Arch Intern Med. 2006;166:1775–1782. doi: 10.1001/archinte.166.16.1775. [DOI] [PubMed] [Google Scholar]
  • 6.Roth T, Coulouvrat C, Hajak G, et al. Prevalence and perceived health associated with insomnia based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition criteria: results from the America Insomnia Survey. Biol Psychiatry. 2011;69:592–600. doi: 10.1016/j.biopsych.2010.10.023. [DOI] [PubMed] [Google Scholar]
  • 7.Fortier-Brochu E, Beaulieu-Bonneau S, Ivers H, Morin CM. Insomnia and daytime cognitive performance: a meta-analysis. Sleep Med Rev. 2012;16:83–94. doi: 10.1016/j.smrv.2011.03.008. [DOI] [PubMed] [Google Scholar]
  • 8.Baglioni C, Battagliese G, Feige B, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135:10–19. doi: 10.1016/j.jad.2011.01.011. [DOI] [PubMed] [Google Scholar]
  • 9.Kraus SS, Rabin LA. Sleep America: managing the crisis of adult chronic insomnia and associated conditions. J Affect Disord. 2012;138:192–212. doi: 10.1016/j.jad.2011.05.014. [DOI] [PubMed] [Google Scholar]
  • 10.Schwartz S, McDowell AW, Cole SR, Cornoni-Huntley J, Hays JC, Blazer D. Insomnia and heart disease: a review of epidemiologic studies. J Psychosom Res. 1999;47:313–333. doi: 10.1016/s0022-3999(99)00029-x. [DOI] [PubMed] [Google Scholar]
  • 11.Laugsand LE, Vatten LJ, Platou C, Janszky I. Insomnia and the risk of acute myocardial infarction: a population study. Circulation. 2011;124:2073–2081. doi: 10.1161/CIRCULATIONAHA.111.025858. [DOI] [PubMed] [Google Scholar]
  • 12.Laugsand LE, Strand LB, Platou C, Vatten LJ, Janszky I. Insomnia and the risk of incident heart failure: a population study. Eur Heart J. 2014;35:1382–1393. doi: 10.1093/eurheartj/eht019. [DOI] [PubMed] [Google Scholar]
  • 13.Li Y, Zhang X, Winkelman JW, et al. Association between insomnia symptoms and mortality: a prospective study of US men. Circulation. 2014;129:737–746. doi: 10.1161/CIRCULATIONAHA.113.004500. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Vgontzas AN, Liao D, Pejovic S, et al. Insomnia with short sleep duration and mortality: the Penn State cohort. Sleep. 2010;33:1159–1164. doi: 10.1093/sleep/33.9.1159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Hublin C, Partinen M, Koskenvuo M, Kaprio J. Heritability and mortality risk of insomnia-related symptoms: a genetic epidemiologic study in a population-based twin cohort. Sleep. 2011;34:957–964. doi: 10.5665/SLEEP.1136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Althuis MD, Fredman L, Langenberg PW, Magaziner J. The relationship between insomnia and mortality among community-dwelling older women. J Am Geriatr Soc. 1998;46:1270–1273. doi: 10.1111/j.1532-5415.1998.tb04544.x. [DOI] [PubMed] [Google Scholar]
  • 17.Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002;59:131–136. doi: 10.1001/archpsyc.59.2.131. [DOI] [PubMed] [Google Scholar]
  • 18.Mallon L, Broman JE, Hetta J. Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. J Intern Med. 2002;251:207–216. doi: 10.1046/j.1365-2796.2002.00941.x. [DOI] [PubMed] [Google Scholar]
  • 19.Daley M, Morin CM, LeBlanc M, Gregoire JP, Savard J, Baillargeon L. Insomnia and its relationship to health-care utilization, work absenteeism, productivity and accidents. Sleep Med. 2009;10:427–438. doi: 10.1016/j.sleep.2008.04.005. [DOI] [PubMed] [Google Scholar]
  • 20.Walsh JK, Engelhardt CL. The direct economic costs of insomnia in the United States for 1995. Sleep. 1999;22(Suppl. 2):S386–S393. [PubMed] [Google Scholar]
  • 21.Stoller MK. Economic effects of insomnia. Clin Ther. 1994;16:873–897. [PubMed] [Google Scholar]
  • 22.Centers for Disease Control and Prevention. [accessed 14.07.20];About the National Health Interview Survey. 2012 < http://www.cdc.gov/nchs/nhis/about_nhis.htm>.
  • 23.National Institutes of Health. NIH State-of-the-Science Conference Statement on manifestations and management of chronic insomnia in adults. NIH Consens State Sci Statements. 2005;22:1–30. [PubMed] [Google Scholar]
  • 24.Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia its treatment. Prevalence and correlates. Arch Gen Psychiatry. 1985;42:225–232. doi: 10.1001/archpsyc.1985.01790260019002. [DOI] [PubMed] [Google Scholar]
  • 25.Kronholm E, Partonen T, Laatikainen T, et al. Trends in self-reported sleep duration and insomnia-related symptoms in Finland from 1972 to 2005: a comparative review and re-analysis of Finnish population samples. J Sleep Res. 2008;17:54–62. doi: 10.1111/j.1365-2869.2008.00627.x. [DOI] [PubMed] [Google Scholar]
  • 26.Calem M, Bisla J, Begum A, et al. Increased prevalence of insomnia and changes in hypnotics use in England over 15 years: analysis of the 1993, 2000, and 2007 National Psychiatric Morbidity Surveys. Sleep. 2012;35:377–384. doi: 10.5665/sleep.1700. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Hsu YW, Ho CH, Wang JJ, Hsieh KY, Weng SF, Wu MP. Longitudinal trends of the healthcare-seeking prevalence and incidence of insomnia in Taiwan: an 8-year nationally representative study. Sleep Med. 2013;14:843–849. doi: 10.1016/j.sleep.2013.02.017. [DOI] [PubMed] [Google Scholar]
  • 28.Pallesen S, Sivertsen B, Nordhus IH, Bjorvatn B. A 10-year trend of insomnia prevalence in the adult Norwegian population. Sleep Med. 2014;15:173–179. doi: 10.1016/j.sleep.2013.10.009. [DOI] [PubMed] [Google Scholar]
  • 29.Janson C, Lindberg E, Gislason T, Elmasry A, Boman G. Insomnia in men-a 10-year prospective population based study. Sleep. 2001;24:425–430. doi: 10.1093/sleep/24.4.425. [DOI] [PubMed] [Google Scholar]
  • 30.Li RH, Wing YK, Ho SC, Fong SY. Gender differences in insomnia-a study in the Hong Kong Chinese population. J Psychosom Res. 2002;53:601–609. doi: 10.1016/s0022-3999(02)00437-3. [DOI] [PubMed] [Google Scholar]
  • 31.Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6:97–111. doi: 10.1053/smrv.2002.0186. [DOI] [PubMed] [Google Scholar]
  • 32.Brook DW, Rubenstone E, Zhang C, Brook JS. Trajectories of cigarette smoking in adulthood predict insomnia among women in late mid-life. Sleep Med. 2012;13:1130–1137. doi: 10.1016/j.sleep.2012.05.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.LeBlanc M, Merette C, Savard J, Ivers H, Baillargeon L, Morin CM. Incidence and risk factors of insomnia in a population-based sample. Sleep. 2009;32:1027–1037. doi: 10.1093/sleep/32.8.1027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Breslau N, Roth T, Rosenthal L, Andreski P. Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry. 1996;39:411–418. doi: 10.1016/0006-3223(95)00188-3. [DOI] [PubMed] [Google Scholar]
  • 35.Hicks RA, Mistry R, Lucero K, Lee L, Pellegrini R. The sleep duration and sleep satisfaction of college students: striking changes over the last decade (1978–1988) Percept Mot Skills. 1989;68:806. doi: 10.2466/pms.1989.68.3.806. [DOI] [PubMed] [Google Scholar]
  • 36.Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4:487–504. [PMC free article] [PubMed] [Google Scholar]

RESOURCES